Rough sleepers are offered one-to-one psychological help in the London borough under an initiative that has also seen frontline professionals given training in supporting their clients.
The vast majority of individuals who find themselves using rough sleeping services have significant histories of trauma and adverse childhood experiences.
Despite this, access to appropriate treatment remains elusive for many. There are a variety of reasons for this, including the traditional split between mental health and substance misuse services and a belief that this group is untreatable. This is compounded by client mistrust of statutory and difficulties attending outpatient appointments due to drug using patterns.
Westminster has the highest number of rough sleepers of any local authority area in the country. At any one time there are an estimated 300 sleeping on the streets.
The council commissions a range of different services and agencies, such as St Mungo’s, to support them through outreach work, hostels and supported housing.
The council’s rough sleeping commissioning team has placed an emphasis on supporting rough sleepers psychologically for the best part of a decade.
This approach – known as psychologically informed environments (PIE) – has seen staff working for the agencies Westminster commissions given training in reflective practice and complex trauma to help them support and understand the mental health needs of the people they work with.
But in 2017, the council started exploring what more could be done in partnership with Dr Brett Grellier Psychology Services (BGPS). Two psychologists were recruited to offer in-reach into one of Westminster’s hostels. They provide one-to-one psychology to those identified by staff as the most vulnerable.
This includes people struggling with bereavement, post-traumatic stress disorder, depression and psychotic disorders. Clients have been taught managing skills for dealing with strong emotions, given cognitive behavioural therapy and a treatment known as EMDR.
Over the first 20 months of the project over 100 treatment sessions were delivered to 15 people.
One of those was Ollie (not his real name). The 40-year-old had a history of getting into fights while sleeping rough. When he was assessed by staff at the hostel, they recognised he had ADHD and met the criteria for post-traumatic stress disorder. He had had a difficult childhood with his mother and step-father, during which he experienced fear, violence and humiliation.
He started having weekly sessions with a psychologist. After six months, during which he had 17 sessions, the improvement was clearly noticeable.
A clinical assessment showed a significant reduction in PTSD symptoms, while he reported improvements in self-esteem and autonomy. He has only been in one altercation in the past three months and was able to use de-escalation techniques to manage it.
Rough Sleeping Commissioning Manager Victoria Aseervatham said investing in this sort of support requires a leap of faith. "It was definitely out of our comfort zone. These sessions were costing us £100 an hour, essentially housing money being used to support people emotionally.
"But we really believe in the importance of looking at people holistically. It is only when you help them deal with some of the complex issues from their lives that you can get on and support them with the symptoms, such as drinking and drug-taking.”
However, Ms Aseervatham said in developing these projects it is important not to look for perfection. “I say it is better to do something badly than not at all.
“There is no point waiting and waiting for the perfect model or prefect time. That can lead to procrastination, delays, stress and anxiety. Get on and try things on a small scale to see if they work – then you can build on it from there.”
How is the approach being sustained?
Following on from the success of the BGPS work, Westminster is now expanding the psychological support offered to rough sleepers.
Last year, South London and Maudsley NHS Trust started providing one to one psychological support in two hostels to complement the work of BGPS. They are also offering training to staff.
Meanwhile, the charity Survivor UK has been commissioned to provide an emotional support worker who is providing 10 hours of help a week. The role is very much community based, working closely with the outreach teams in an opportunistic way.
Ms Aseervatham said: “She will take any opportunity that comes her way to engage with people. It could be over a coffee or an informal chat. We have seen the benefit that one-to-one work has had in the hostel and want to try to build on that.”
Rough Sleeping Commissioning Manager
Westminster City Council